Laparoscopic radical resection for large-volume renal carcinoma: via retroperitoneal or transperitoneal approach?

Purpose: The aim of this study was to investigate the clinical efficacy and safety of laparoscopic radical resection through retroperitoneal and transperitoneal approaches in treating large-volume renal carcinoma.

Methods: A total of 116 patients with large-volume (>7 cm) renal carcinoma underwent laparoscopic radical resection for renal carcinoma. Among them, 58 were treated through retroperitoneal approach (Retroperitoneal group), and 58 were treated through transperitoneal approach (Abdominal group). The levels of interleukin-6 (IL-6), IL-12 and IL-1β in the patients were compared before and after operation. Furthermore, the levels of tumor markers were explored, and the tumor recurrence and survival of the patients were followed up and recorded.

Results: Compared with those in Abdominal group, the patients in Retroperitoneal group had remarkably shorter operation time, time of renal artery occlusion, time of intestinal exhaust and length of hospital stay after operation as well as notably smaller intraoperative blood loss. The levels of IL-6, IL-12 and IL-1β were elevated after operation in both groups in comparison with those before operation. Besides, the concentrations of serum CA50, CA125 and CEA declined obviously after treatment in the two groups in contrast with those before treatment, while no statistically significant differences in the concentrations of serum CA50, CA125 and CEA were observed between the two groups after treatment. The follow-up results indicated that the average survival and progression-free survival were 18.3 months and 16.0 months, respectively, in Retroperitoneal group, and 19.1 months and 16.8 months, respectively, in Abdominal group.

Conclusions: The retroperitoneal laparoscopic radical resection for large-volume renal carcinoma possesses exact therapeutic effects, and it has shorter operation time, less blood loss, fewer impacts on inflammatory responses in patients and higher safety than transperitoneal laparoscopic radical resection.